Background/Purpose: Calcinosis is a painful, debilitating manifestation in connective tissue diseases. Recent findings suggest a link between proton pump inhibitor (PPI) use and calcinosis in systemic sclerosis (SSc), but this association has not been studied in dermatomyositis (DM). This study aims to evaluate the relationship between PPI use and the presence of calcinosis in patients with DM and to confirm this association in SSc.

Methods: We conducted a retrospective, cross-sectional study using DM and SSc cohorts from Pontificia Universidad Católica de Chile. Adults meeting ACR/EULAR criteria for DM or SSc were included. Clinical data, PPI exposure, and presence of calcinosis was extracted from electronic medical records. PPI exposure score was calculated as described by Host et al.(1) as total duration of use in years multiplied by total daily PPI equivalent dose. Logistic regression was used to assess the association between PPI use and calcinosis, adjusting for clinical variables that were significant in univariate analysis as well as potential confounders.

Results: A total of 107 patients with SSc and 83 with DM were included. Calcinosis was present in 23 SSc patients (21.5%) and 18 DM patients (21.7%). Among SSc patients, those with calcinosis had significantly longer median disease duration from both Raynaud’s phenomenon (RP) onset (12 vs. 3 years) and first non-RP symptoms (5 vs. 2.5 years), higher prevalence of digital ulcers (52.2% vs. 22.6%, p=0.0151), more frequent gastroesophageal reflux disease (GERD) symptoms (86.9% vs. 57.1%), greater PPI use (95% vs. 72.6%, p=0.02), and a markedly higher median PPI exposure score (4580 vs. 293, p< 0.0001). In DM, patients with calcinosis had a higher frequency of ulcers (27.8% vs. 1.54%, p=0.0003), but no significant differences in PPI use, although a numeric trend toward longer PPI exposure was noted (3.7 vs. 0.1 years, p=0.08). In multivariate analysis of the SSc cohort, adjusting for disease duration from first RP, longer disease duration (OR 1.11, 95% CI 1.04–1.19, p=0.0013), PPI use for 5–10 years (OR 7.41, 95% CI 1.2–45.6, p=0.03), and PPI use for more than 10 years (OR 16.4, 95% CI 2.5–107.7, p=0.0036) were significantly associated with calcinosis. In contrast, PPI use for less than 5 years was not associated with calcinosis.

Conclusion: Prolonged PPI use was significantly associated with calcinosis in patients with SSc, confirming its role as a potentially modifiable risk factor. No significant association was found in DM, although a trend toward longer PPI use in those with calcinosis warrants further study. These findings raise important questions about the long-term safety of PPI therapy in patients with calcinosis and suggest that the pathophysiology and risk factors of calcinosis may differ between SSc and DM.References: 1. Host LV, Campochiaro C, Afonso A, Nihtyanova SI, Denton CP, Ong VH. High proton pump inhibitor exposure increases risk of calcinosis in systemic sclerosis. Rheumatology (Oxford). 2020.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-calcinosis-with-proton-pump-inhibitor-use-in-adult-dermatomyositis-and-systemic-sclerosis/